Ho Teaching Hospital

Because BMI can be adjusted, a greater BMI may be associated with poorer outcomes and an increased risk of surgical complications. Additionally, smoking is another factor that negatively affects the musculoskeletal system, triggering inflammatory processes that hinder healing, complications and lead to poor postoperative outcomes in orthopedic surgery. Although the role of smoking on meniscal tissue has not be fully understood yet, it should be taken into consideration as an important factor affecting the results of meniscus surgery. The aim of this study was to evaluate the relationships between smoking, high BMI, and the outcomes of arthroscopic treatment of isolated medial meniscus. This study involved 239 consecutive patients who underwent knee arthroscopy and met the inclusion criteria: torn medial meniscus, positive specific clinical tests for medial meniscus tear or mechanical symptoms, not relieved by conventional methods– conservative treatment at least of 3 months, torn medial meniscus with various morphology, positive results supported by MRI, the diagnostics with X-ray revealed Kellgren and Lawrence Grade 0 or 1 at the baseline visit, intraoperatively recognized chondromalacia and concomitant medial meniscus tear. Demographic data was collected, including sex, age, body mass index (BMI), smoking habit, education, and previous surgery. The postoperative outcomes were assessed using The Knee Injury and Osteoarthritis Outcome Score. A mean preoperative KOOS score was 51.77 for smokers and 51.70 for non-smokers (p = 0.18). On the other hand, the mean postoperative KOOS score was 66.80 for smokers and 66.71 for non-smokers (p = 0.45). Moreover, the mean BMI score was 27.49 in the smokers group and 27.89 in the non-smokers group (p = 0.17).A statistically significant, but weak, correlation was established between the postoperative KOOS Score and BMI value (p = 0.03; r = -0.1355). In this study, we found no evidence of an association between smoking and functional outcomes following arthroscopic medial meniscus tear treatment. Moreover, patients’ postoperative functional outcomes with growing BMI are deteriorated, and additionally BMI values were increasing with age.

Hypertrophic cardiomyopathy is the most common genetic cardiomyopathy. The apical variant, also known as Yamaguchi syndrome, is a rare condition that is reportedly more prevalent in Asian populations. It is characterized by hypertrophy predominantly limited to the left ventricular apex, with a classic "ace of spades" shaped left ventricular cavity. We present a 61-year-old male of West African descent with a chest pain syndrome and deep inverted precordial T-waves on 12-lead electrocardiography. Two-dimensional echocardiography demonstrated focal left ventricular hypertrophy limited to the apex, and speckle-tracking imaging showed reduced apical strain, findings consistent with apical hypertrophic cardiomyopathy (HCM). Risk assessment for sudden cardiac death was low. A previous invasive coronary artery angiography reported normal epicardial coronary arteries. The patient was started on carvedilol 6.25 mg orally twice daily, with resolution of the chest pain and, so far, a generally optimal quality of life after four months of follow-up.

Abstract Background Clinical complications are often predicted with separate sigmoid outputs, even when the target labels arise from related pathophysiological processes. This paper asks whether output-layer choice should reflect both predictive convenience and the biological structure assumed among complications. The central premise is that label-dependence mechanisms are explicit hypotheses about comorbidity, not generic modelling additions. Methods Output-head assumptions were compared across two clinically distinct multi-label prediction tasks. In Type 2 diabetes (T2D), six heads were evaluated for nephropathy, neuropathy, and retinopathy: independent baseline, linear additive, multiplicative, symmetric conditional random field (CRF), residual multilayer perceptron (MLP), and combined additive–multiplicative. In myocardial infarction (MI), four heads were evaluated for ventricular tachycardia, ventricular fibrillation, and atrioventricular block: independent baseline, linear additive, multiplicative, and symmetric CRF. All experiments used five training data fractions and seven independent seeds, with the same shared-backbone protocol within each disease setting. Results In T2D, the symmetric CRF gave the most consistent improvement pattern, ranking highest at full data and at the two lowest data fractions while adding only three interaction parameters. At 20% training data, it was the only interaction head whose aggregate mean exceeded the independent baseline. The residual MLP, despite 123 interaction parameters, remained below the baseline across all T2D fractions. In MI, rankings changed across fractions: the multiplicative head led at 80% and 60%, the CRF led at 100% and 20%, and the baseline led at 40%. The combined additive–multiplicative head did not improve robustness in T2D and showed the largest negative baseline-relative deviations at lower fractions. Conclusion The findings support a biology-guided view of output-layer design. A small constrained mechanism was most useful when its symmetry matched the shared microvascular structure of T2D, whereas the heterogeneous electrophysiology of MI produced no stable winner. Output-layer choice should therefore be reported and defended as an assumption about disease structure instead of a routine hyperparameter decision. Author summary Many clinical prediction models treat complications as separate outcomes, even when clinicians know they often arise together. We studied whether the last layer of a model should reflect that biological knowledge. We compared several output heads across two disease settings: Type 2 diabetes, where nephropathy, neuropathy, and retinopathy share a common microvascular origin, and myocardial infarction, where electrical complications arise from a mixture of shared and location-specific mechanisms. We found that a small symmetric CRF head was most useful in the diabetes task, especially when training data were limited, while no single interaction head dominated in myocardial infarction. This suggests that modelling comorbidity is not only a technical choice; it is a statement about how disease processes relate to one another. Our results encourage researchers to report and justify output-layer design as part of the clinical modelling argument, rather than treating it as a routine hyperparameter.

BackgroundSubstandard and falsified antimicrobials threaten public health due to their role in resistance development. Pharmacies, as key access points for antimicrobials, can play a crucial role in detecting these products. In this study, a visual assessment tool which incorporates a novel packaging quality index estimate, was developed and used in pharmacies to evaluate antimicrobial packaging and flag suspicious products.MethodsA cross-sectional study was conducted in 23 community pharmacies in the Ho Municipality between November 2023 and February 2024. The developed checklist contains indicators on registration compliance, language & medical information, batch information consistency, and product security of the antimicrobials. The tool was validated, and its use on randomly sampled antimicrobials informed the development of the packaging quality index from regression analysis involving weights determined from principal component analysis of the results. Statistical analyses were performed with SPSS (version 26.0) and OriginPro (version 2022).ResultsThe packages and labels of the 275 antimicrobials evaluated were antibacterials (41%), antiprotozoals (28%), antifungals (22%) and antivirals (9%). Most products were of foreign origin (58.5%) and labelled in English (98%). Significant variations were observed in the registration compliance and product security indicators by origin and antimicrobial class (p < 0.01). Batch information consistency varied significantly across the antimicrobial classes (p < 0.01), whereas language & medical information quality remained consistent. The packaging quality index scores followed a normal distribution, with majority (95.6%) referred to as moderate quality (Index: 1.81-5.34). High quality packages (2.2%; Index: 5.47-5.53) were mostly observed in antibacterials of local origin (66.7%) whereas the poor-quality packages observed (2.2%; Index: 1.48-1.78) were mostly antibacterials of foreign origin (66.7%).ConclusionThis study identified packaging quality issues among the antimicrobials investigated which may suggest potential risk to falsification. Routine antimicrobials packages assessment with developed tools like the packaging quality index could help pick up early signals of substandard and falsified antimicrobials for further regulatory investigations and action.

AIM:To examine national trends and disparities in cardiovascular mortality associated with systemic connective tissue disorders (CTDs) in the United States from 1999 to 2020. METHODS:We analyzed mortality data from the CDC WONDER database. Deaths were included where CTD (ICD-10: M05, M06, M30-M35) was the underlying cause and cardiovascular disease was a contributing cause. Age-adjusted mortality rates (AAMRs) per 1 000 000 were calculated using the 2000 US Standard Population. Joinpoint regression identified annual and average annual percentage changes. Analyses were stratified by sex, race/ethnicity, census region, and urbanization. Disease subgroup and state-level analyses were performed. RESULTS:Between 1999 and 2020, 47 752 cardiovascular deaths occurred among individuals with systemic CTDs. The national AAMR declined from 14.4 to 8.2 per 1 000 000 (AAPC: -2.68%, 95% CI: -2.89 to -2.47, p < 0.001). Females had consistently higher mortality than males (average AAMR: 13.5 vs. 5.9 per 1 000 000; p < 0.001). Non-Hispanic Black individuals had the highest rates (average AAMR: 14.9 per 1 000 000), with widening disparities after 2008. Rural areas had higher mortality than urban areas (average AAMR: 11.4 vs. 9.9 per 1 000 000; p = 0.01). Subgroup analyses revealed heterogeneous trends across CTD subtypes, with SLE showing the slowest improvement (AAPC: -1.87%) and dermatomyositis the steepest decline (AAPC: -4.98%). State-level AAMRs ranged 2.2-fold, from 6.3 (District of Columbia) to 13.6 (Montana) per 1 000 000. CONCLUSIONS:Cardiovascular mortality associated with systemic CTDs has declined significantly over two decades; however, persistent racial disparities, urban-rural differences, heterogeneous disease-specific trends, and substantial geographic variation underscore the need for targeted, equitable interventions in this high-risk population.